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Digitally signed by Tad Pierson
<br />TOrI Pierson Date:2D2zg6.DTis:R:1s
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<br />�1 BACKDAN-01
<br />TFRT
<br />DATE(MMA10rrYYY)
<br />5/4/2022
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ics) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />Maury, Donnell & Parr
<br />24 Commerce St.
<br />Baltimore, MD 21202
<br />C MEACT
<br />PHONE FAX
<br />(A/C, No, Eat: (410) 685.4625 IA/c, No):(410) 685-3071
<br />E'MdRILE
<br />AD SS:
<br />INSURERS AFFORDING COVERAGE
<br />NAICR
<br />INSURERA:GreatAmerican Insurance Com an
<br />16691
<br />INSURED
<br />INSURER B
<br />INSURER C:
<br />Backhaus Dance
<br />INSURER D
<br />PO BOX 5890
<br />Orange, CA 92863
<br />INSURER E
<br />NSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADOLSUBR
<br />POLICY NUMBER
<br />POLICYEFF
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �X OCCUR
<br />X
<br />GLP3961460
<br />6/312022
<br />61312023
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE T ERENTED
<br />EHEMISE5MED
<br />1,000,000
<br />EXP (My one arson
<br />20,000
<br />PERSONAL B ADV INJURY
<br />11000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />X POLICY DjEeT LOG
<br />OTHER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />PRODUCTS-COMPIOPAGG
<br />2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />WNE
<br />AUTOS ONLY ALOITNOS O&
<br />COMBINED SINGLE LIMIT
<br />fEa accident)
<br />BODILY INJURY Perperson)
<br />INJURY (Per accident
<br />BODILY
<br />P OF.ERZt NMAGE
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />DED RETENTION$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERTUABILITY YIN
<br />ANY PROPRIETOIVPARTNERIEXECtrrIVE ❑
<br />QQF�FICERRdEMBER EXCLUDED?
<br />(atantlatgry In NH)
<br />If as, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />I PER OTH-
<br />E
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE- EA EMPLOYE
<br />E.L. DISEASE- POLICY LIMB
<br />A
<br />A
<br />Abuse & Molestation
<br />Abuse & Molestation
<br />X
<br />X
<br />GLP3961460
<br />GLP3961460
<br />613/2022
<br />613/2022
<br />6/3/2023
<br />6/3/2023
<br />Each Abuse
<br />Aggregate Limit
<br />11000,000
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more space is required
<br />The City of Santa Ana, Risk Management, its o lcers, employees, agents, representatives, and volunteers are additional insured. Coverage Is primary and
<br />non-contributory. 30 day prior Written notice of cancellation is in favor of the City of Santa Ana, Risk Management, its officers, employees, agents,
<br />representatives, and volunteers.
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE
<br />THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVY .....
<br />- Rld MaraglktltOMrart
<br />1THORI2E REPRESENTATIVE
<br />//
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<br />ACOHD 25 (2015103) ©1988-2015 ACORD C( V 14
<br />The ACORD name and logo are registered marks of ACORD
<br />
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